Get This Doc Out of the Pharmacy Loop

• Patient leaves request for refill with pharmacy.
• Pharmacy faxes me request for refill authorization.
• Patient goes to pharmacy expecting to pick refill which is not there.
• Patient leaves message on my voice mail: "Where's my refill!?"
• I retrieve voice mail.
• I call pharmacy: a) I did not receive refill request or b) Pharmacy did not send refill request
• Pharmacy faxes refill request.
• I fax refill or order via eprescribing service.

 I suggested a solution to tech support at the eprescribing service I have been using, allscripts.com: Give the patient limited access to and control over the refill process. Instead of calling the pharmacy the patient would access her account at the eprescribing Web site. She would click on the prescription she wanted to refill and indicate the name of the pharmacy she wanted to use. My eprescibing service alerts me to the request. I access the Web site, check the patient's name, the drug, last date filled, etc. With a click I authorize the refill, and the pharmacy receives the order. The system alerts the patient who can check the status of the whole process at any time, and may opt for email notification from the pharmacy when the prescription has been prepared for pick up. The system could even alert the patient if there is a problem, like the medication is not in stock. The patient can then select a different pharmacy.

What do you think?

What is a REfill?

You’ve gotta love iscribe.com.

It always seemed clear to me:

“Do NOT refill.” at the bottom of my prescriptions.

For years it must have been clear to pharmacists. Then, inexplicably, at a pharmacy in a small town where I had placed the same order for the same patient every month for years, a pharmacist who otherwise seems to speak and understand the English language (unlike too many pharmacists), decided that I must have faxed the prescription order, complete with number of pills to dispense, just to tell them not to fill it.

Like I would waste my time doing that when I could be blogging or tweeting.

I had to look at the prescription again. It did not say, “Do not fill.” It said do not REfill. By telephone I assured the pharmacist that I did in fact want the drug dispensed to the patient. Once.

Then it happened again at a different pharmacy.

I contacted the state pharmacy board. Confirming my belief, a gentleman there told me that indeed fill or order means dispense while REfill means dispense again at a later time. When the patient contacts the pharmacy. Without contacting the doctor again.

Just to avoid further wasted time I changed the prescription form for these language-challenged pharmacies to:

“Refills: zero”

So far it seems to work.

William Safire must be turning over in his grave.

It seems I am not alone. For almost a year now when iscribe.com, the e-prescribing service I use most, contacted me via the Web with a refill authorization request, the form demanded that I specify the number of REfills. Alas, iscribe, too, has cried “uncle” in the face of prescribing illiteracy, apparently dumbing down in an attempt to avoid confusion. Today the iscribe refill authorization form reads:

“Total # of dispensings:”

Let’s hope we can all agree on what that means.